Central retinal artery occlusion associated with patent foramen ovale: a case report and literature review

Patent foramen ovale might cause cryptogenic strokes, including retinal artery occlusion. Herein, we describe a previously healthy young man who presented with central retinal artery occlusion in the setting of patent foramen ovale and explore the need for transesophageal echocardiogram for its diagnosis. Cardiovascular workup and neuroimaging were unremarkable. Transthoracic echocardiogram bubble study shunt and subsequent transesophageal disclosed patent foramen ovale. This congenital anomaly was the likely conduit for a thrombo-embolic occlusion. We identified seven patients foramen ovale associated with central retinal artery occlusion in the literature. Transthoracic echocardiogram was diagnostic in only one patient (14.3%), whereas echocardiogram was required to reveal patent foramen ovale in the remaining six (85.7%). Our case and the previous reports support the link between central retinal artery occlusion and patent foramen ovale. Therefore, providers should consider the transesophageal echocardiogram during the initial evaluation of young patients without immediately identifiable causes of retinal artery occlusion.